Contribution Of Cyclosporin A Eye Drops In The Management Of Severe Sicca Syndrome In Sjogren's S.Yndrome.

The severe sicca syndrome observed in Sjogren's syndrome is a potentially blinding disease, requiring multiple long-term treatments. The objective of our work is to evaluate the evolution of severe sicca syndrome during Sjogren's syndrome treated with cyclosporin A eye drops.

We analyzed 89 eyes of 75 patients.  We analyzed for each patient BCVA, BUT, Schirmer test, optical aberrations and quality of life before and after treatment. Visual acuity was measured on the Snellen scale and analyzed in log-mar. BUT was measured using the slit lamp and tear secretion measured using the Schirmer test1. Optical aberrations were evaluated using a corneal topographer. We used the DEQ-5 questionnaire translated into Arabic and validated to assess quality of life.

We conducted a non-randomized single-center prospective descriptive study over 18 months. We included adult patients with severe sicca syndrome secondary to Sjogren's syndrome. We indicated cyclosporin immediately in cases of extensive corneal ulcer and/or limbal or corneal neovascularization which corresponds to 23 patients. We indicated cyclosporine secondarily in case of non-response to treatment or worsening of corneal lesions and to avoid or interrupt corticosteroids treatment.

Our population included 65 women/10 men with an average age of 55.76 years ±12.11. The Sjogren's syndrome was primary in 15 cases; 4 patients were monophthalmos. We carried out a univariate analysis of all the judgment criteria: BCVA, BUT, Schirmer's test; optical aberrations as well as the DEQ-5 score. Administration of cyclosporin A eye drops statistically significantly (p≤0.05) improved BCVA, patient quality of life and Schirmer values. On the other hand, there was no statistically significant relationship for the values of BUT and optical aberrations.

Cyclosporine A eye drops made it possible to avoid prolonged corticosteroid therapy, to reduce conjunctival and corneal apoptotic phenomena and to combat the inflammatory phenomena of the disease. its contribution, in our study, was evident mainly in cases of extensive corneal ulcer and low visual acuity.
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